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Objective To evaluate the clinical value of bedside ultrasound measurement of optic nervesheath diameter (ONSD) in the prognosis of severe traumatic brainin jury (sTBI). Methods Atotal of 78 sTBI patients admitted to Department of Neurosurgery ICU of He'nan Provincial People's Hospital from April 2017 to April 2019 were enrolled. Intracranial pressure (ICP) monitoring probe was placed when the patient was admitted, and bedside ultrasound was used to detect the ONSD. The values of ONSD in supine position and 30° head⁃up position, 30min before and after ventilation, and 30min before and after mannitol treatment were observed and analyzed. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of ONSD for unfavourable prognosis of sTBI patients. Results The mean ICP in unfavourable prognosis group [Glasgow Outcome Scale (GOS) score 1-3] was higher than that in favourable prognosis group (GOS score 4-5; t=2.111, P=0.038). After 30° head⁃up position, 30 min after ventilation and mannitol treatment, the values of ONSD were lower than supine position (F=6.644, P= 0.012),and30 min befor eventilation (F=4.492, P=0.037) and mannitol treatment (F=5.552, P=0.021), and ONSD in unfavourable prognosis group were higher than those in favourable prognosis group (posture change: F=16.751, P=0.000; ventilation treatment: F=29.776, P=0.000; application of mannitol: F= 12.465, P=0.002). There was a positive correlation between ONSD and ICP (r=0.691, P=0.000). ONSD at 5.53 mm was the optimal threshold for unfavourable prognosis, the area under the curve (AUC) was 0.776 (95%CI: 0.826-0.978, P =0.000). The sensitivity was 91.52% and the specificity was 87.14%. Conclusions Dynamic detection of ONSD by bedside ultrasound is helpful to evaluate the prognosis of sTBI, and guide the precise treatment of severe ICP. DOI：10.3969/j.issn.1672⁃6731.2020.08.006